By vgreene, 4 November, 2019 Monitor for sx; anticipate onset (hrs, days) based on opioid duration of action.
By vgreene, 4 November, 2019 Advise on OD risks if pt abruptly returns to previous higher opioid dose;2 consider naloxone
By vgreene, 4 November, 2019 Set expectations, offer nonopioid tx, monitor for w/d sx; regularly re-eval risk-benefit & psycho/social support needs
By vgreene, 4 November, 2019 Individualize continuation or gradual taper of buprenorphine, based on shared decision-making, risk-benefit eval
By vgreene, 4 November, 2019 Transition2 to buprenorphine, which treats both opioid use disorder & pain, w/ better risk profile than opioids. If pregnant w/ opioid use disorder: Medication-assisted tx preferred over detoxification2
By vgreene, 4 November, 2019 Assess/tx comorbid mental illness (anxiety, depression, PTSD). If serious mental illness, high suicide risk/ideation: behavioral health consult before opioid taper. If also on BZD, coordinate gradual BZD taper3 to avoid BZD w/d (anxiety, hallucinations, s
By vgreene, 4 November, 2019 Arrange transition1 to medication assisted tx eg buprenorphine for opioid use disorder 2 assess tx comorbid mental illness use shared decision making
By vgreene, 4 November, 2019 If unable to taper: Consider opioid use disorder;6 if on high doses despite worse pain/function, consider transition to buprenorphine (even w/o opioid use disorder)